{"id":799,"date":"2024-05-28T18:10:31","date_gmt":"2024-05-28T18:10:31","guid":{"rendered":"https:\/\/www.drlanglois.ca\/book-a-consultation\/"},"modified":"2024-07-12T15:03:20","modified_gmt":"2024-07-12T15:03:20","slug":"book-a-consultation","status":"publish","type":"page","link":"https:\/\/www.drlanglois.ca\/en\/book-a-consultation\/","title":{"rendered":"Book a consultation"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;grid&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; z_index=&#8221;&#8221; el_id=&#8221;reserve&#8221;][vc_column][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\">Book a consultation<\/h1>\n<p style=\"text-align: center;\">So that we can accurately assess your pain level, make an accurate diagnosis and develop a personalized treatment plan, please complete the form below to book an appointment.<\/p>\n<p>[\/vc_column_text][vc_empty_space]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f958-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/799#wpcf7-f958-o1\" method=\"post\" class=\"wpcf7-form init default\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"958\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f958-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:958,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-autre-raison&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-raison&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;group-autre-sensation&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-sensation&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;group-approuches&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-approches&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;group-autre-circonstance&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;checkbox-circonstance&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;group-travail&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-travail&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]},{&quot;then_field&quot;:&quot;group-anticoagulants&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-anticoagulants&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Yes&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div class=\"form-grid\">\n    <div class=\"form-row\">\n        <h2>PERSONAL DATA<\/h2>\n    <\/div>\n    <div class=\"form-row col-2\">\n        <label>First name\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"text-prenom\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-prenom\" \/><\/span>\n        <\/label>\n        <label>Last name\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"text-nom\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-nom\" \/><\/span>\n        <\/label>\n    <\/div>\n    <div class=\"form-row col-3\">\n        <label>Phone\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"tel-30\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-30\" \/><\/span>\n        <\/label>\n        <label>Email\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"email-228\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-228\" \/><\/span>\n        <\/label>\n        <label>Date of birth\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"date-512\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" max=\"2026-09-13\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-512\" \/><\/span>\n        <\/label>\n \n    <\/div>\n   <div class=\"form-row\">\n<h4>Choose the clinic for your visit:<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-locations\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-locations\" value=\"Gatineau clinic\" \/><span class=\"wpcf7-list-item-label\">Gatineau clinic<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-locations\" value=\"Montreal clinic\" \/><span class=\"wpcf7-list-item-label\">Montreal clinic<\/span><\/label><\/span><\/span><\/span>\n   <\/div>\n    <div class=\"form-row\">\n        <h2>MEDICAL QUESTIONNAIRE<\/h2>\n    <\/div>\n<\/div>\n<h4>Reason for consultation:<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-raison\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"migraine\" \/><span class=\"wpcf7-list-item-label\">migraine<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"back pain\" \/><span class=\"wpcf7-list-item-label\">back pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"neck pain\" \/><span class=\"wpcf7-list-item-label\">neck pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"shoulder pain\" \/><span class=\"wpcf7-list-item-label\">shoulder pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"elbow pain\" \/><span class=\"wpcf7-list-item-label\">elbow pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"hand pain\" \/><span class=\"wpcf7-list-item-label\">hand pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"knee pain\" \/><span class=\"wpcf7-list-item-label\">knee pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"hip pain\" \/><span class=\"wpcf7-list-item-label\">hip pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"joint pain\" \/><span class=\"wpcf7-list-item-label\">joint pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"sciatic nerve\" \/><span class=\"wpcf7-list-item-label\">sciatic nerve<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-raison[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-autre-raison\" data-orig_data_id=\"group-autre-raison\"  data-class=\"wpcf7cf_group\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-autre-raison\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please specify\" value=\"\" type=\"text\" name=\"text-autre-raison\" \/><\/span>\n<\/div>\n<h4>How long has the pain been more severe?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-combien\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-combien\" \/><\/span>\n<h4>How did the pain start?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-douleur\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-douleur\" value=\"Gradually\" \/><span class=\"wpcf7-list-item-label\">Gradually<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-douleur\" value=\"Following an accident\" \/><span class=\"wpcf7-list-item-label\">Following an accident<\/span><\/label><\/span><\/span><\/span>\n<h4>Choose the sensation of pain<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-sensation\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"tingling\" \/><span class=\"wpcf7-list-item-label\">tingling<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"cramping\" \/><span class=\"wpcf7-list-item-label\">cramping<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"exhausting\" \/><span class=\"wpcf7-list-item-label\">exhausting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"shooting\" \/><span class=\"wpcf7-list-item-label\">shooting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"heavy\" \/><span class=\"wpcf7-list-item-label\">heavy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"continuous\" \/><span class=\"wpcf7-list-item-label\">continuous<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"stabbing\" \/><span class=\"wpcf7-list-item-label\">stabbing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"aching\" \/><span class=\"wpcf7-list-item-label\">aching<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"nagging\" \/><span class=\"wpcf7-list-item-label\">nagging<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"burning\" \/><span class=\"wpcf7-list-item-label\">burning<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"throbbing\" \/><span class=\"wpcf7-list-item-label\">throbbing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"excruciating\" \/><span class=\"wpcf7-list-item-label\">excruciating<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"deep\" \/><span class=\"wpcf7-list-item-label\">deep<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"sharp\" \/><span class=\"wpcf7-list-item-label\">sharp<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"unbearable\" \/><span class=\"wpcf7-list-item-label\">unbearable<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"numb\" \/><span class=\"wpcf7-list-item-label\">numb<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-sensation[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-autre-sensation\" data-orig_data_id=\"group-autre-sensation\"  data-class=\"wpcf7cf_group\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-autre-sensation\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please specify\" value=\"\" type=\"text\" name=\"text-autre-sensation\" \/><\/span>\n<\/div>\n<h4>Is the pain :<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-que\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-que\" value=\"constant\" \/><span class=\"wpcf7-list-item-label\">constant<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-que\" value=\"variable\" \/><span class=\"wpcf7-list-item-label\">variable<\/span><\/label><\/span><\/span><\/span>\n<h4>Please rate your pain by choosing the one number that best describes your pain at its <strong>WORST<\/strong> in the past 24 hours.<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-intense\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required range\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-intense\" \/><\/span>\n<h4>Please rate your pain by choosing the one number that best describes your pain at its <strong>LEAST<\/strong> in the last 24 hours.<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-faible\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required range\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-faible\" \/><\/span>\n<h4>Please rate your pain by choosing the one number that best describes your pain on <strong>AVERAGE<\/strong>.<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-general\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required range\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-general\" \/><\/span>\n<h4>Please rate your pain by choosing the one number that tells how much pain you have <strong>RIGHT NOW<\/strong>.<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-moment\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required range\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-moment\" \/><\/span>\n<h4>Current pain control medications<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-medicaments\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-medicaments\"><\/textarea><\/span>\n<h4>During the last 24 hours, what <strong>RELIEF<\/strong> have you received from the treatments or medications you are taking? Indicate the number of improvement obtained.<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-pendant\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required pendant\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-pendant\" \/><\/span>\n<h4>Medications that have been tried<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-medicaments-qui\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-medicaments-qui\"><\/textarea><\/span>\n<h4>Has cannabis been tried?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-cannabis\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-cannabis\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-cannabis\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<h4>Have non-pharmacological approaches been tried?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-approches\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-approches\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-approches\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-approuches\" data-orig_data_id=\"group-approuches\"  data-class=\"wpcf7cf_group\">\n<h4>What non-pharmacological approaches have been tried?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-approuches\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-approuches[]\" value=\"physiotherapy\" \/><span class=\"wpcf7-list-item-label\">physiotherapy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-approuches[]\" value=\"chiropractic\" \/><span class=\"wpcf7-list-item-label\">chiropractic<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-approuches[]\" value=\"massage therapy\" \/><span class=\"wpcf7-list-item-label\">massage therapy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-approuches[]\" value=\"osteopathy\" \/><span class=\"wpcf7-list-item-label\">osteopathy<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-approuches[]\" value=\"acupuncture\" \/><span class=\"wpcf7-list-item-label\">acupuncture<\/span><\/label><\/span><\/span><\/span>\n<h4>Were they useful?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-elles\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-elles\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-elles\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n<h4>Under what circumstances is the pain aggravated?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-circonstance\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"walking\" \/><span class=\"wpcf7-list-item-label\">walking<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"standing\" \/><span class=\"wpcf7-list-item-label\">standing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"sitting\" \/><span class=\"wpcf7-list-item-label\">sitting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"turning\" \/><span class=\"wpcf7-list-item-label\">turning<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"physical activity\" \/><span class=\"wpcf7-list-item-label\">physical activity<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"sport\" \/><span class=\"wpcf7-list-item-label\">sport<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-circonstance[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-autre-circonstance\" data-orig_data_id=\"group-autre-circonstance\"  data-class=\"wpcf7cf_group\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-circonstance\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please specify\" value=\"\" type=\"text\" name=\"text-circonstance\" \/><\/span>\n<\/div>\n<div class=\"multi-quest\">\n<h4>Indicate the number that best describes how, during the past 24 hours, pain has interfered with your:<\/h4>\n<h5><em>A.<\/em> General activity<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-activite\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-activite\" \/><\/span>\n<h5><em>B.<\/em> Mood<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-humeur\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-humeur\" \/><\/span>\n<h5><em>C.<\/em> Walking ability<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-capacite\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-capacite\" \/><\/span>\n<h5><em>D.<\/em> Normal work <span>(includes both work outside the home and housework)<\/span><\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-habituel\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-habituel\" \/><\/span>\n<h5><em>E.<\/em> Relations with other people<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-relation\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-relation\" \/><\/span>\n<h5><em>F.<\/em> Sleep<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-sommeil\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required indi\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-sommeil\" \/><\/span>\n<h5><em>G.<\/em> Enjoyment of life<\/h5>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-vivre\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required range\" aria-required=\"true\" aria-invalid=\"false\" value=\"3\" type=\"text\" name=\"text-vivre\" \/><\/span>\n<\/div>\n<h4>What is your occupation?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-occupation\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-occupation\" \/><\/span>\n<h4>Are you off work?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-travail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-travail\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-travail\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-travail\" data-orig_data_id=\"group-travail\"  data-class=\"wpcf7cf_group\">\n<h4>Since what date?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-quelle-date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-quelle-date\" \/><\/span>\n<\/div>\n<h4>Are you taking anticoagulants?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-anticoagulants\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-anticoagulants\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-anticoagulants\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<div data-id=\"group-anticoagulants\" data-orig_data_id=\"group-anticoagulants\"  data-class=\"wpcf7cf_group\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-anticoagulants\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Write the name of the drug\" value=\"\" type=\"text\" name=\"text-anticoagulants\" \/><\/span>\n<\/div>\n<h4>Do you suffer from:<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-souffrez\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"high blood pressure\" \/><span class=\"wpcf7-list-item-label\">high blood pressure<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"cardiac disease\" \/><span class=\"wpcf7-list-item-label\">cardiac disease<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"pulmonary disease (COPD, asthma)\" \/><span class=\"wpcf7-list-item-label\">pulmonary disease (COPD, asthma)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"diabetes\" \/><span class=\"wpcf7-list-item-label\">diabetes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"sleep apnea\" \/><span class=\"wpcf7-list-item-label\">sleep apnea<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-souffrez[]\" value=\"take blood thinners\" \/><span class=\"wpcf7-list-item-label\">take blood thinners<\/span><\/label><\/span><\/span><\/span>\n<h4>Other medical conditions:<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-conditions\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-conditions\" \/><\/span>\n<h4>Do you smoke tobacco?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-tabac\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-tabac\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-tabac\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<h4>Do you smoke cannabis?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-fumez-cannabis\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-fumez-cannabis\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-fumez-cannabis\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<h4>What do you expect from the consultation?<\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-attentes\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-attentes\"><\/textarea><\/span>\n<h4>Upload your medical reports of your X-rays\/images, if you have them <em>(magnetic resonance, CT scan, x-ray):<\/em><\/h4>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"file-918\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"image\/*,application\/pdf\" aria-invalid=\"false\" type=\"file\" name=\"file-918\" \/><\/span>\n<div class=\"accept\">\n<h4>Consent to Communicate with the Clinic<\/h4>\n<p>Before contacting Dr. Langlois' clinic, we invite you to review the following information.<\/p>\n<ul class=\"checkmarks\">\n<li>Electronic communications (including email, online forms, and other Internet-based methods of communication) involve inherent security risks. While the clinic takes reasonable measures to protect the confidentiality of your personal information, no computer system is completely immune to cyberattacks or unauthorized access. By choosing to communicate with the clinic electronically, you acknowledge and accept these risks.<\/li>\n<li>Dr. Langlois' clinic is a private medical clinic that does not participate in the Qu\u00e9bec Health Insurance Plan (RAMQ). Unless otherwise specified, the services provided by the clinic are not covered by RAMQ, and fees may apply.<\/li>\n<li>By submitting this form or otherwise communicating with the clinic, you confirm that you have read, understood, and accepted the information above.<\/li>\n<\/ul>\n<\/div>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SUBMIT\" \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;grid&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; z_index=&#8221;&#8221; el_id=&#8221;reserve&#8221;][vc_column][vc_column_text] Book a consultation So that we can accurately assess your pain level, make an accurate diagnosis and develop a personalized treatment plan, please complete the form below to book an appointment. [\/vc_column_text][vc_empty_space][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"full_width.php","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-799","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Book a consultation to reduce your pain in Montreal, Ottawa, Gatineau<\/title>\n<meta name=\"description\" content=\"Book an appointment with Dr. Langlois - Anesthesiologist. Pain management specialist in Montreal, Gatineau and Ottawa\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.drlanglois.ca\/en\/book-a-consultation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Book a consultation to reduce your pain in Montreal, Ottawa, Gatineau\" \/>\n<meta property=\"og:description\" content=\"Book an appointment with Dr. Langlois - Anesthesiologist. 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